Black mothers twice as likely to be hospitalised with perinatal mental illness

Black mothers are twice as likely as white mothers to be admitted to hospital with perinatal mental illnesses, NHS data shows.

The figures, based on an analysis by the Guardian newspaper, show that between 2020 and 2023, 777 people were admitted to hospitals in NHS England with a primary diagnosis for puerperal mental disorders (ie disorders occurring in the six weeks after childbirth).

Black women made up 12% of the 777 admitted, even though they only accounted for 5% of births in the same period. There were 0.91 hospital admissions per 1,000 birth deliveries for perinatal mental illnesses among Black women, compared with 0.43 admissions per 1,000 for their white counterparts.

Dr Rosena Allin-Khan, the Labour MP for Tooting, told the Guardian that the disparities were “hugely concerning”, and that “every new mother deserves the very best support when having a child”.

Dr Katie Merwick, a senior clinical research fellow and honorary consultant psychiatrist with NHS Lothian, said that the factors contributing to the disparity included “structural inequality, with women from ethnic minorities on average being worse off socioeconomically, difficulties accessing services, and cultural attitudes towards mental illness.”

Allin-Khan added: “We know all too well that Black women face worse outcomes in maternal health, and it is horrifying to see these play out in maternal mental health services too.”

‘Postcode lottery’ in perinatal mental health services

The figures also showed that Black women were more than three times as likely as their white counterparts to be admitted to hospital for severe instances of perinatal mental illness and behavioural disorders associated with the six weeks immediately after childbirth.

For severe puerperal mental health admissions, there were 0.7 admissions per 1,000 deliveries for black patients, compared with 0.2 admissions per 1,000 deliveries for white patients. Patients from Asian and mixed-race backgrounds also had an increased risk of hospital admissions. There were 0.25 admissions per 1,000 births for Asian patients and 0.54 admissions per 1,000 births for mixed-race patients.

The hospital admissions analysed by the Guardian ranged from mild to severe mental and behaviour disorders, and included puerperal mental disorders, which can include postpartum psychosis.

Up to 1,200 new mothers across England and Wales experience postpartum psychosis each year, according to the Royal College of Psychiatrists. The condition is regarded as a medical emergency that can cause depression, confusion, hallucinations and delusions, and – when left untreated – can lead to grave consequences. The illness most commonly presents itself in the fortnight after childbirth.

The figures further serve to highlight recognised racial disparities in maternal outcomes. Black women are almost four times more likely to die in childbirth and during the perinatal period as their white counterparts.

A record 57,000 new and expectant mothers received specialist support for mental health problems in 2023, according to NHS England.

Birte Harlev-Lam, the executive director midwife of the Royal College of Midwives, said: “The provision of perinatal mental health services across the UK and particularly in areas of high social deprivation, where often women need the most support, for too long has been a postcode lottery. Action is also needed nationally with a multi-agency approach to better support black, Asian and minority ethic women who are suffering with perinatal mental health issues.

“There needs to be more joint working between clinicians so that issues are spotted earlier, better training – and the time to undertake such training – and specialist midwives to meet the increasingly complex needs of these women and families. Mental ill-health ranks with physical factors as one of the leading causes of maternal deaths in the UK, and yet this is not reflected in the resources allocated to it.”